Passive dissection features for ultrasonic surgical instrument

ABSTRACT

An apparatus for operating on tissue includes a body assembly, a shaft, an acoustic waveguide, and an end effector. The end effector includes an ultrasonic blade, a clamp arm, and a blade guard. The ultrasonic blade is in acoustic communication with the waveguide. The clamp arm is configured to pivot toward and away from the ultrasonic blade. The clamp arm has a first tine. The blade guard extends from the shaft. The blade guard has a longitudinally extending arm defining a concave pathway and a second tine located distal to the longitudinally extending arm. The ultrasonic blade is partially housed within the concave pathway. The first tine and the second tine are configured to grasp tissue when the clamp arm pivots toward the ultrasonic blade.

BACKGROUND

A variety of surgical instruments include an end effector having a bladeelement that vibrates at ultrasonic frequencies to cut and/or sealtissue (e.g., by denaturing proteins in tissue cells). These instrumentsinclude piezoelectric elements that convert electrical power intoultrasonic vibrations, which are communicated along an acousticwaveguide to the blade element. The precision of cutting and coagulationmay be controlled by the surgeon's technique and adjusting the powerlevel, blade edge, tissue traction and blade pressure.

Examples of ultrasonic surgical instruments include the HARMONIC ACE®Ultrasonic Shears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONICFOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades,all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examplesof such devices and related concepts are disclosed in U.S. Pat. No.5,322,055, entitled “Clamp Coagulator/Cutting System for UltrasonicSurgical Instruments,” issued Jun. 21, 1994, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 5,873,873, entitled“Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,”issued Feb. 23, 1999, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” filed Oct.10, 1997, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,325,811, entitled “Blades with Functional BalanceAsymmetries for use with Ultrasonic Surgical Instruments,” issued Dec.4, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,773,444, entitled “Blades with Functional BalanceAsymmetries for Use with Ultrasonic Surgical Instruments,” issued Aug.10, 2004, the disclosure of which is incorporated by reference herein;and U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” issued Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Still further examples of ultrasonic surgical instruments are disclosedin U.S. Pub. No. 2006/0079874, entitled “Tissue Pad for Use with anUltrasonic Surgical Instrument,” published Apr. 13, 2006, now abandoned,the disclosure of which is incorporated by reference herein; U.S. Pub.No. 2007/0191713, entitled “Ultrasonic Device for Cutting andCoagulating,” published Aug. 16, 2007, now abandoned, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2007/0282333,entitled “Ultrasonic Waveguide and Blade,” published Dec. 6, 2007, nowabandoned, the disclosure of which is incorporated by reference herein;U.S. Pub. No. 2008/0200940, entitled “Ultrasonic Device for Cutting andCoagulating,” published Aug. 21, 2008, now abandoned, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2009/0105750,entitled “Ergonomic Surgical Instruments,” published Apr. 23, 2009, nowissued as U.S. Pat. No. 8,623,027 on Jan. 7, 2014, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2010/0069940,entitled “Ultrasonic Device for Fingertip Control,” published Mar. 18,2010, issued as U.S. Pat. No. 9,023,071 on May 5, 2015, the disclosureof which is incorporated by reference herein; and U.S. Pub. No.2011/0015660, entitled “Rotating Transducer Mount for UltrasonicSurgical Instruments,” published Jan. 20, 2011, issued as U.S. Pat. No.8,461,744 on Jun. 11, 2013, the disclosure of which is incorporated byreference herein; and U.S. Pub. No. 2012/0029546, entitled “UltrasonicSurgical Instrument Blades,” published Feb. 2, 2012, issued as U.S. Pat.No. 8,591,536 on Nov. 26, 2013, the disclosure of which is incorporatedby reference herein.

Some of ultrasonic surgical instruments may include a cordlesstransducer such as that disclosed in U.S. Pub. No. 2012/0112687,entitled “Recharge System for Medical Devices,” published May 10, 2012,issued as U.S. Pat. No. 9,381,058 on Jul. 5, 2016, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0116265,entitled “Surgical Instrument with Charging Devices,” published May 10,2012, now abandoned, the disclosure of which is incorporated byreference herein; and/or U.S. Pat. App. No. 61/410,603, filed Nov. 5,2010, entitled “Energy-Based Surgical Instruments,” the disclosure ofwhich is incorporated by reference herein.

While several surgical instruments and systems have been made and used,it is believed that no one prior to the inventors has made or used theinvention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a perspective view of an exemplary ultrasonic surgicalinstrument;

FIG. 2 depicts a side elevational view of the end effector of theinstrument of FIG. 1, in a closed configuration;

FIG. 3A depicts a perspective view of the end effector of FIG. 2, in anopen configuration;

FIG. 3B depicts a perspective view of the end effector of FIG. 2, in aclosed configuration;

FIG. 4 depicts a perspective view of the surgical instrument of FIG. 1with an exemplary alternative end effector;

FIG. 5A depicts a perspective view of the end effector of FIG. 4, in anopen configuration;

FIG. 5B depicts a perspective view of the end effector of FIG. 4, in aclosed configuration;

FIG. 6A depicts a cross-sectional rear view of the end effector of FIG.4, in the open configuration as shown in FIG. 5A;

FIG. 6B depicts a cross-sectional rear view of the end effector of FIG.4, in the closed configuration as shown in FIG. 5B;

FIG. 7 depicts a cross-sectional perspective view of the end effector ofFIG. 4;

FIG. 8 depicts a bottom plan view of a selected portion of the endeffector of FIG. 4;

FIG. 9 depicts a cross-sectional bottom view of a selected portion ofthe end effector of FIG. 4;

FIG. 10A depicts a perspective view of another alternative end effectorthat may be readily incorporated into the surgical instrument of FIG. 1,where the end effector is in an open configuration

FIG. 10B depicts a perspective view of the end effector of FIG. 10A,where the end effector is in a first closed configuration;

FIG. 10C depicts a perspective view of the end effector of FIG. 10A,where the end effector is in a second closed configuration;

FIG. 11A depicts a cross-sectional rear view of the end effector of FIG.10A, taken along line 11A-11A of FIG. 10A, where the end effector is inthe open configuration as shown in FIG. 10A;

FIG. 11B depicts a cross-sectional rear view of the end effector of FIG.10A, taken along line 11B-11B of FIG. 10B, where the end effector is inthe first closed configuration as shown in FIG. 10B;

FIG. 11C depicts a cross-sectional rear view of the end effector of FIG.10A, taken along line 11C-11C—of FIG. 10C, where the end effector is inthe second closed configuration as shown in FIG. 10C;

FIG. 12A depicts a cross-sectional side view of another alternative endeffector that may be readily incorporated into the surgical instrumentof FIG. 1, where the end effector is in an open configuration;

FIG. 12B depicts a cross-sectional side view of the end effector of FIG.12A, where the end effector is in a first closed configuration;

FIG. 12C depicts a cross-sectional side view of the end effector of FIG.12A, where the end effector is in a second closed configuration;

FIG. 13A depicts a cross-sectional rear view of the end effector of FIG.12A, where the end effector is in the open configuration as shown inFIG. 12A;

FIG. 13B depicts a cross-sectional rear view of the end effector of FIG.12A; where the end effector is in the first closed configuration asshown in FIG. 12B;

FIG. 13C depicts a cross-sectional rear view of the end effector of FIG.12A; where the end effector is in the second closed configuration asshown in FIG. 12C;

FIG. 14A depicts a cross-sectional side view of another alternative endeffector that may be readily incorporated into the surgical instrumentof FIG. 1, where the end effector is in an open configuration;

FIG. 14B depicts a cross-sectional side view of the end effector of FIG.14A, where the end effector is in a first closed configuration;

FIG. 14C depicts a cross-sectional side view of the end effector of FIG.14A, where the end effector is in a second closed configuration;

FIG. 15A depicts a cross-sectional rear view of the end effector of FIG.14A, where the end effector is in the open configuration as shown inFIG. 14A;

FIG. 15B depicts a cross-sectional rear view of the end effector of FIG.14A; where the end effector is in the first closed configuration asshown in FIG. 14B;

FIG. 15C depicts a cross-sectional rear view of the end effector of FIG.14A; where the end effector is in the second closed configuration asshown in FIG. 14C;

FIG. 16A depicts a side view of an exemplary alternative surgicalinstrument with the end effector of FIG. 4, where the end effector is inan open configuration;

FIG. 16B depicts a side view of the surgical instrument of FIG. 16A,where the end effector is in a first closed configuration;

FIG. 16C depicts a side view of the surgical instrument of FIG. 16A,where the end effector is in a second closed configuration;

FIG. 17 depicts a perspective view of another alternative end effectorthat may be readily incorporated into the surgical instruments of FIG. 1or FIG. 16A, where the end effector is in a closed configuration;

FIG. 18 depicts a top plan view of the end effector of FIG. 17;

FIG. 19 depicts a bottom plan view of a selected portion of the endeffector of FIG. 17;

FIG. 20 depicts a perspective view of an exemplary alternative surgicalinstrument, where the surgical instrument is in an open configuration;

FIG. 21A depicts a side elevational view of the surgical instrument ofFIG. 20, where the surgical instrument is in the open configuration asshown in FIG. 20; and

FIG. 21B depicts a side elevational view of the surgical instrument ofFIG. 20, where the surgical instrument is in a closed configuration.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to a human or robotic operator of the surgicalinstrument. The term “proximal” refers the position of an element closerto the human or robotic operator of the surgical instrument and furtheraway from the surgical end effector of the surgical instrument. The term“distal” refers to the position of an element closer to the surgical endeffector of the surgical instrument and further away from the human orrobotic operator of the surgical instrument.

I. Exemplary Ultrasonic Surgical Instrument for Open Surgical Procedures

FIG. 1 illustrates an exemplary ultrasonic surgical instrument (100)that is configured to be used in open surgical procedures. Instrument(100) of this example comprises a handle assembly (120), a shaftassembly (130), and an end effector (140). Handle assembly (120)comprises a body (122) including a finger grip ring (124) and a pair ofbuttons (126). Instrument (100) also includes a clamp arm assembly (150)that is pivotable toward and away from body (122). Clamp arm (150)includes a shank (152) with a thumb grip ring (154). Thumb grip ring(154) and finger grip ring (124) together provide a scissor grip type ofconfiguration. It should be understood, however, that various othersuitable configurations may be used, including but not limited to apistol grip configuration.

Shaft assembly (130) comprises an outer sheath (132) extending distallyfrom body (122). As best seen in FIGS. 2-3B, end effector (140)comprises an ultrasonic blade (142), a clamp arm (144), and a cap (148)secured to the distal end of sheath (132). Ultrasonic blade (142)extends distally from cap (148). Clamp arm (144) is an integral featureof clamp arm assembly (150). Clamp arm (144) includes a clamp pad (146)facing ultrasonic blade (142). Clamp arm assembly (150) is pivotallycoupled with outer sheath (132) via a pin (156). Clamp arm (144) ispositioned distal to pin (156); while shank (152) and thumb grip ring(154) are positioned proximal to pin (156). Thus, as shown in FIGS.3A-3B, clamp arm (144) is pivotable toward and away from ultrasonicblade (142) based on pivoting of thumb grip ring (154) toward and awayfrom body (122) of handle assembly (120). It should therefore beunderstood that an operator may squeeze thumb grip ring (154) towardbody (122) to thereby clamp tissue between clamp pad (146) andultrasonic blade (142) to transect and/or seal the tissue. In someversions, one or more resilient members are used to bias clamp arm (144)to the open configuration shown in FIG. 3A. By way of example only, sucha resilient member may comprise a leaf spring, a torsion spring, and/orany other suitable kind of resilient member.

Referring back to FIG. 1, an ultrasonic transducer assembly (112)extends proximally from body (122) of handle assembly (120). Transducerassembly (112) is coupled with a generator (116) via a cable (114).Transducer assembly (112) receives electrical power from generator (116)and converts that power into ultrasonic vibrations through piezoelectricor magnetorestrictive principles. Generator (116) may include a powersource and control module that is configured to provide a power profileto transducer assembly (112) that is particularly suited for thegeneration of ultrasonic vibrations through transducer assembly (112).By way of example only, generator (116) may comprise a GEN 300 sold byEthicon Endo-Surgery, Inc. of Cincinnati, Ohio. In addition or in thealternative, generator (116) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2011/0087212, entitled“Surgical Generator for Ultrasonic and Electrosurgical Devices,”published Apr. 14, 2011, issued as U.S. Pat. No. 8,986,302 on Mar. 12,2015, the disclosure of which is incorporated by reference herein. Itshould also be understood that at least some of the functionality ofgenerator (116) may be integrated into handle assembly (120), and thathandle assembly (120) may even include a battery or other on-board powersource such that cable (114) is omitted. Still other suitable forms thatgenerator (116) may take, as well as various features and operabilitiesthat generator (116) may provide, will be apparent to those of ordinaryskill in the art in view of the teachings herein.

Ultrasonic vibrations that are generated by transducer assembly (112)are communicated along an acoustic waveguide (138), which extendsthrough shaft assembly (130) to reach ultrasonic blade (142). Waveguide(138) is secured within shaft assembly (130) via a pin (not shown),which passes through waveguide (138) and shaft assembly (130). This pinis located at a position along the length of waveguide (138)corresponding to a node associated with resonant ultrasonic vibrationscommunicated through waveguide (138). As noted above, when ultrasonicblade (142) is in an activated state (i.e., vibrating ultrasonically),ultrasonic blade (142) is operable to effectively cut through and sealtissue, particularly when the tissue is being clamped between clamp pad(146) and ultrasonic blade (142). It should be understood that waveguide(138) may be configured to amplify mechanical vibrations transmittedthrough waveguide (138). Furthermore, waveguide (138) may includefeatures operable to control the gain of the longitudinal vibrationsalong waveguide (138) and/or features to tune waveguide (138) to theresonant frequency of the system.

In the present example, the distal end of ultrasonic blade (142) islocated at a position corresponding to an anti-node associated withresonant ultrasonic vibrations communicated through waveguide (138), inorder to tune the acoustic assembly to a preferred resonant frequencyf_(o) when the acoustic assembly is not loaded by tissue. Whentransducer assembly (112) is energized, the distal end of ultrasonicblade (142) is configured to move longitudinally in the range of, forexample, approximately 10 to 500 microns peak-to-peak, and in someinstances in the range of about 20 to about 200 microns at apredetermined vibratory frequency f_(o) of, for example, 55.5 kHz. Whentransducer assembly (112) of the present example is activated, thesemechanical oscillations are transmitted through the waveguide to reachultrasonic blade (142), thereby providing oscillation of ultrasonicblade (142) at the resonant ultrasonic frequency. Thus, when tissue issecured between ultrasonic blade (142) and clamp pad (46), theultrasonic oscillation of ultrasonic blade (142) may simultaneouslysever the tissue and denature the proteins in adjacent tissue cells,thereby providing a coagulative effect with relatively little thermalspread. In some versions, an electrical current may also be providedthrough ultrasonic blade (142) and/or clamp pad (146) to also seal thetissue.

An operator may activate buttons (126) to selectively activatetransducer assembly (112) to thereby activate ultrasonic blade (142). Inthe present example, two buttons (126) are provided—one for activatingultrasonic blade (142) at a low power and another for activatingultrasonic blade (142) at a high power. However, it should be understoodthat any other suitable number of buttons and/or otherwise selectablepower levels may be provided. For instance, a foot pedal may be providedto selectively activate transducer assembly (112). Buttons (126) of thepresent example are positioned such that an operator may readily fullyoperate instrument (100) with a single hand. For instance, the operatormay position their thumb in thumb grip ring (154), position their ringfinger in finger grip ring (124), position their middle finger aboutbody (122), and manipulate buttons (126) using their index finger. Ofcourse, any other suitable techniques may be used to grip and operateinstrument (100); and buttons (126) may be located at any other suitablepositions.

The foregoing components and operabilities of instrument (100) aremerely illustrative. Instrument (100) may be configured in numerousother ways as will be apparent to those of ordinary skill in the art inview of the teachings herein. By way of example only, at least part ofinstrument (100) may be constructed and/or operable in accordance withat least some of the teachings of any of the following, the disclosuresof which are all incorporated by reference herein: U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,783,524; U.S. Pub. No.2006/0079874, now abandoned; U.S. Pub. No. 2007/0191713, now abandoned;U.S. Pub. No. 2007/0282333, now abandoned; U.S. Pub. No. 2008/0200940,now abandoned; U.S. Pub. No. 2010/0069940, issued as U.S. Pat. No.9,023,071 on May 5, 2015; U.S. Pub. No. 2011/0015660, issued as U.S.Pat. No. 8,461,744 on Jun. 11, 2013; U.S. Pub. No. 2012/0112687, issuedas U.S. Pat. No. 9,381,058 on Jul. 5, 2016; U.S. Pub. No. 2012/0116265,now abandoned; U.S. Pub. No. 2014/0005701, now issued as U.S. Pat. No.9,393,037 on Jul. 19, 2016; U.S. Pub. No. 2014/0114334, issued as U.S.Pat. No. 9,095,367 on Aug. 4, 2015; and/or U.S. patent application Ser.No. 14/031,665, now abandoned. Additional merely illustrative variationsfor instrument (100) will be described in greater detail below. Itshould be understood that the below described variations may be readilyapplied to instrument (100) described above and any of the instrumentsreferred to in any of the references that are cited herein, amongothers.

II. Exemplary End Effectors with Passive Dissection Features

In some instances, it may be desirable to grasp and/or manipulate tissuevia end effector (140) without ultrasonic blade (142) contacting tissue.For example, during operation, ultrasonic blade (142) may build upexcess thermal energy. Passively grasping tissue via end effector (140)may lead to contact between tissue and ultrasonic blade (142). If prioractivation of ultrasonic blade (142) leads to a buildup of excessthermal energy, contact between ultrasonic blade (142) and tissue maylead to undesired effects, such as burning of tissue. Additionally, anoperator may desire to simply grasp tissue or perform a blunt dissectionon tissue without transmitting mechanical oscillations throughultrasonic blade (142). For example, an operator may desire to grasptissue with end effector (140) in order to effectively pinch and/orcrush tissue between end effector (140), thereby severing graspedtissue. An operator may also desire to insert end effector (140), in aclosed configuration, between two organs or anatomical parts that areattached and/or stuck together. The operator may then open end effector(140) to an open configuration in order to pry apart or separateattached organs or anatomical parts.

It should be understood from the foregoing that may be advantageous toconfigure end effector (140) in a way that facilitates use of endeffector (140) to perform simple grasping or blunt dissection tasks,without necessarily having the tissue contact blade (142). The followingdescription provides various examples of how end effector (140) may bereconfigured to facilitate simple grasping or blunt dissection tasks.Other variations will be apparent to those of ordinary skill in the artin view of the teachings herein.

A. End Effector with Distal, Laterally Extending Tines

FIGS. 4-9 show an end effector (240) that may be readily incorporatedinto ultrasonic surgical instrument (100) described above. End effector(240) comprises an ultrasonic blade (242), a clamp arm (244), and ablade guard (260) secured to the distal end of sheath (132). Ultrasonicblade (242) is integrally connected to a waveguide (238). Ultrasonicblade (242) and waveguide (238) are substantially similar to ultrasonicblade (142) and waveguide (138) described above. Therefore, waveguide(238) may communicate ultrasonic vibrations to ultrasonic blade (242).

Clamp arm (244) includes a clamp pad (246) facing ultrasonic blade(142). Clamp arm (244) is substantially similar to clamp arm (144)described above, while clamp pad (246) is substantially similar to clamppad (146) described above, with differences described below. Therefore,clamp arm (244) is an integral feature of clamp arm assembly (150).Additionally, clamp arm (244) is pivotable toward and away fromultrasonic blade (242) based on pivoting of thumb grip ring (154) towardand away from body (133) of handle assembly (120).

A clamp tine (248) is positioned at the distal end of clamp arm (244).Clamp tine (248) comprises a laterally extending body (247) and agrasping surface (249). Laterally extending body (247) projectslaterally away from the longitudinal axis defined by ultrasonic blade(242), although this is merely optional. The offset position oflaterally extending body (247) relative to the longitudinal axis definedby ultrasonic blade (242) may allow an operator to better visualizeclamp tine (248) during use of end effector (240). Grasping surface(249) provides a plurality of ridges in this example, however it shouldbe understood that ridges are merely optional. For instance, graspingsurface (249) may comprise a flat surface, an inclined surface, a wavedsurface, a knurled surface, or have any other suitable geometry as wouldbe apparent to one having ordinary skill in the art in view of theteachings herein. As will be described in greater detail bellow, clamptine (248) is configured to rotate with clamp arm (244) toward and awayfrom blade guard (260) to passively grasp and/or perform bluntdissections on tissue.

Blade guard (260) comprises a cap (262), a longitudinally extending arm(264), and a guard tine (268). Cap (262) is secured to the distal end ofsheath (132). Additionally, cap (262) defines a tubular passage (261),which waveguide (238) extends through. As best seen in FIG. 9, tubularpassage (261) is sized to accommodate the outer diameter of waveguide(238) such that waveguide (238) does not contact the inner surface ofcap (262) when waveguide (238) mechanically oscillates.

Longitudinally extending arm (264) unitarily extends from cap (262)along the length of ultrasonic blade (242). As best shown in FIGS. 6A-9,longitudinally extending arm (264) defines a hollow or concave pathway(265) that houses a portion of ultrasonic blade (242). In particular,longitudinally extending arm (264) may house ultrasonic blade (242) sothat the portion of ultrasonic blade (242) facing toward clamp pad (266)is exposed while the portion of ultrasonic blade (242) facing away fromclamp pad (266) is confined within longitudinally extending arm (264).As will be described in greater detail below, longitudinally extendingarm (264) may act as a heat guard for ultrasonic blade (242).

Concave pathway (265) of longitudinally extending arm (264) isdimensioned to form a gap between the outer diameter of ultrasonic blade(242) and the inner surface of longitudinally extending arm (264)defining concave pathway (265). The gap formed by concave pathway (265)is large enough so that ultrasonic blade (242) does not contact theinner surface of longitudinally extending arm (264) when ultrasonicblade (242) mechanically oscillates. This may prevent unwanted contactbetween ultrasonic blade (242) and blade guard (260).

Guard tine (268) is positioned at the distal end of longitudinallyextending arm (264). Guard tine (268) comprises a laterally extendingbody (267) and a grasping surface (269). Laterally extending body (267)projects laterally away from the longitudinal axis defined by ultrasonicblade (242), although this is merely optional. The offset position oflaterally extending body (267) relative to the longitudinal axis definedby ultrasonic blade (242) may allow an operator to better visualizeguard tine (268) during use of end effector (240). Grasping surface(269) of guard tine (268) forms a flat surface facing toward graspingsurface (249) of clamp tine (248). While in the current example,grasping surface (269) forms a flat surface, this is merely optional.For instance, grasping surface (269) may include a plurality of ridges,an include surface, a waved surface, a knurled surface, or have anyother suitable geometry as would be apparent to one having ordinaryskill in the art in view of the teachings herein.

It should be understood that laterally extending body (267) of guardtine (268) extends in the same general direction of laterally extendingbody (247) of clamp tine (248). While the current example showslaterally extending bodies (267, 247) extending in a linear fashion,laterally extending body (267) of guard tine (268) and laterallyextending body (247) of clamp tine (248) may extend to form a curvewhile in the closed position. For instance, laterally extending bodies(267, 247) may curve upwardly and away from the plane defined by theclamping surface of clamp pad (246). Additionally, while the currentexample shows laterally extending bodies (267, 247) extendingperpendicularly relative to blade (242), any other suitable angle may beused as would be apparent to one having ordinary skill in the art inview of the teachings herein. For example, blade (242) could have acurved profile while clamp tine (248) and guard tine (268) extend pastblade (242) along the same curved profile.

Grasping surface (269) of guard tine (268) and grasping surface (249) ofclamp tine (248) at least partially align in both longitudinal andlateral directions while end effector (240) is in a closedconfiguration. In other words, grasping surfaces (249, 269) arepositioned so that rotation of clamp arm (244) toward ultrasonic blade(242) will cause contact between grasping surfaces (249, 269); or atleast provide a sufficient distance between grasping surfaces (249, 169)to enable grasping and/or manipulation of tissue between graspingsurfaces (249, 269). Although the current figures show clamp tine (248)extending beyond guard tine (268), guard tine (268) may be dimensionedequal to or greater than the dimensions of clamp tine (248). As will bedescribed in greater detail below, this may allow for grasping surfaces(249, 269) to interact with each other in order to passively grasp orpassively sever tissue captured between grasping surfaces (249, 269)when clamp arm (244) rotates toward ultrasonic blade (242).

FIGS. 5A-6B show end effector (240) transition from an openconfiguration (FIGS. 5A and 6A) to a closed configuration (FIGS. 5B and6B). In exemplary use, an operator may rotate clamp arm (244) towardultrasonic blade (242) so that grasping surfaces (249, 269) align tograsp tissue. The operator may either move instrument (100) in order tomove grasped tissue or further rotate tines (248, 268) together in orderto form a blunt dissection. Additionally or alternatively, the operatormay rotate clamp arm (244) so that tissue is captured between clamp pad(246) and ultrasonic blade (242), then activate ultrasonic blade (242)in order to cut through and seal tissue. Therefore, an operator maychoose between either performing a blunt dissection (or simple graspingof tissue), or operating on tissue with an active ultrasonic blade(242), with one single end effector (240) being capable of performingall of these kinds of tasks. While in the current example, tines (248,268) are used to grasp tissue and/or form a blunt dissection, tines(248, 268) may also be dimensioned and manipulated to perform finedissection of tissue.

Additionally, an operator may manipulate tissue by transitioning endeffector (240) from a closed configuration (FIGS. 5B and 6B) to an openconfiguration (FIGS. 5A and 6A). For instance, the operator may insertend effector (240) in a closed configuration between two organs oranatomical parts that are attached and/or stuck together. Once endeffector (240) is placed in the desired location, the operator may openend effector (240) to separate the two organs or anatomical partswithout exposing ultrasonic blade (242) to the targeted structures. Inother words, clamp arm (244) and blade guard (260) may sufficientlyshield ultrasonic blade (242) from tissue while end effector (240) is ina closed configuration such that end effector (240) may be insertedbetween two organs or anatomical parts in a closed configuration withoutimparting undesired heat to the tissue. Subsequently, end effector (240)may transition to an opened configuration so that the outer surface ofblade guard (260) and the outer surface of clamp arm (244) make contactwith the desired anatomical structure and separate the tissue layerswithout unwanted contact between the tissue and ultrasonic blade (242).

B. End Effector with Two Stage Closure and Resilient Tines

FIGS. 10A-11C show another alternative end effector (340) that may bereadily incorporated into ultrasonic surgical instrument (100) describedabove. While end effector (240) is configured to transition from an openconfiguration to a closed configuration, as shown in FIGS. 5A-6B, endeffector (340) is configured to transition from an open configuration,as shown in FIGS. 10A and 11A, to a first closed configuration, as shownin FIGS. 10B and 11B, and finally to a second closed configuration, asshown in FIGS. 10C and 11C. As will be described in greater detailbelow, the first closed configuration may allow an operator to passivelygrasp and/or manipulate desired tissue while the second closedconfiguration may allow an operator to capture tissue between anultrasonic blade and a clamp pad with sufficient force required to cutthrough and seal tissue with an activated ultrasonic blade.

End effector (340) of this example comprises an ultrasonic blade (342),a clamp arm (344), and a blade guard (360) secured to the distal end ofsheath (132). Ultrasonic blade (342) is integrally connected to awaveguide (338). Ultrasonic blade (342) and waveguide (338) aresubstantially similar to ultrasonic blade (142, 242) and waveguide (138,238) described above. Therefore, waveguide (338) may communicateultrasonic vibrations to ultrasonic blade (342).

Clamp arm (344) includes a clamp pad (346) facing ultrasonic blade(342). Clamp arm (344) is substantially similar to clamp arm (244)described above, while clamp pad (346) is substantially similar to clamppad (246) described above, with differences described below. Therefore,clamp arm (344) is an integral feature of clamp arm assembly (150).Additionally, clamp arm (344) is pivotable toward and away fromultrasonic blade (342) based on pivoting of thumb grip ring (154) towardand away from body (133) of handle assembly (120).

A clamp tine (348) is positioned at the distal end of clamp arm (344).Clamp tine (348) comprises a laterally extending body (347) and agrasping surface (349). Laterally extending body (347) projectslaterally away from the longitudinal axis defined by ultrasonic blade(342), although this is merely optional. The offset position oflaterally extending body (347) relative to the longitudinal axis definedby ultrasonic blade (342) may allow an operator to better visualizeclamp tine (348) during use of end effector (340). Grasping surface(349) of this example has a plurality of ridges, however it should beunderstood that ridges are merely optional. For instance, graspingsurface (349) may have a flat surface, an inclined surface, a wavedsurface, a knurled surface or have any other suitable geometry as wouldbe apparent to one having ordinary skill in the art in view of theteachings herein. As will be described in greater detail bellow, clamptine (348) is configured to rotate with clamp arm (344) toward and awayfrom blade guard (360) to passively grasp and/or perform bluntdissections on targeted tissue.

Blade guard (360) comprises a cap (362), a longitudinally extending arm(364) and a resiliently flexible guard tine (368). Cap (362) issubstantially similar to cap (262) as described above. Therefore, cap(362) is secured to the distal end of sheath (132). Additionally, cap(362) defines a tubular passage (361), which waveguide (338) extendsthrough. As best seen in FIGS. 10A-10C, tubular passage (361) is sizedto accommodate the outer diameter of waveguide (338) such that waveguide(338) does not contact the inner surface of cap (362) when waveguide(338) mechanically oscillates.

Longitudinally extending arm (364) is substantially similar tolongitudinally extending arm (264) described above, with differencesdescribed below. Therefore, longitudinally extending arm (364) unitarilyextends from cap (362) along the length of ultrasonic blade (342). Asbest shown in FIGS. 11A-11C, longitudinally extending arm (364) definesa hollow or concave pathway (365) that houses a portion of ultrasonicblade (342). In particular, longitudinally extending arm (364) may houseultrasonic blade (342) so that the portion of ultrasonic blade (342)facing toward clamp pad (366) is exposed while the portion of ultrasonicblade (342) facing away from clamp pad (366) is confined withinlongitudinally extending arm (364). As will be described in greaterdetail below, longitudinally extending arm (364) may act as a heat guardfor ultrasonic blade (342).

Concave pathway (365) of longitudinally extending arm (354) isdimensioned to form a gap between the outer diameter of ultrasonic blade(342) and the inner surface of longitudinally extending arm (354)defining concave pathway (365). The gap formed by concave pathway (365)is large enough so that ultrasonic blade (342) does not contact theinner surface of longitudinally extending arm (354) when ultrasonicblade (342) mechanically oscillates. This may prevent unwanted contactbetween ultrasonic blade (342) and blade guard (360).

Resiliently flexible guard tine (368) is positioned at the distal end oflongitudinally extending arm (264). Resiliently flexible guard tine(368) is made out of a material that is sufficiently resilient to allowtine (368) to flex relative to longitudinally extending arm (364) inresponse to an external force; and to allow tine (368) to return to anunaltered position when the external force is no longer applied.

Resiliently flexible guard tine (368) comprises a laterally extendingbody (367) and a grasping surface (349). Laterally extending body (347)projects laterally away from the longitudinal axis defined by ultrasonicblade (342), although this is merely optional. The offset position oflaterally extending body (367) relative to the longitudinal axis definedby ultrasonic blade (342) may allow an operator to better visualizeguard tine (368) during use of end effector (340). Grasping surface(369) of guard tine (368) forms a flat surface facing at an obliqueangle toward grasping surface (349) of clamp tine (348). While in thecurrent example, grasping surface (369) forms a flat surface, this ismerely optional. For instance, grasping surface (369) may include aplurality of ridges, an include surface, a waved surface, a knurledsurface, or may have any other suitable geometry as would be apparent toone having ordinary skill in the art in view of the teachings herein.

FIGS. 10A-11C show end effector (340) transition from an openconfiguration (FIGS. 10A and 11A) to a first closed configuration (FIGS.10B and 11B), and further to a second closed configuration (FIGS. 10Cand 11C). As mentioned above, and as shown in FIGS. 11A-11B, graspingsurface (369) of guard tine (368) forms an oblique angle with graspingsurface (349) of clamp tine (348) when guard tine (368) is in anunaltered position. When an operator closes end effector (340) to thefirst closed configuration, as shown from FIGS. 10A-10B and 11A-11B, thefree end of guard tine (368) not attached to longitudinally extendingarm (364) is positioned to first make contact with grasping surface(349) of clamp tine (348). The contact between the free end of guardtine (368) and grasping surface (349) enables grasping and/ormanipulation of tissue between grasping surfaces (349, 369). Theoperator may either move instrument (100) in order to move graspedtissue or further rotate tines (348, 368) together in order to form ablunt dissection. However, dimensioning tines (348, 368) to form a bluntdissection by further rotating tines (348, 368) is merely optional.

As described above, resiliently flexible guard tine (368) is made out ofa material that flexes relative to longitudinally extending arm (364) inresponse to an external force. As shown in FIGS. 10C and 11C, theoperator may further rotate clamp arm (344) toward ultrasonic blade(342) such that clamp tine (348) imparts an external force on guard tine(368), thereby flexing tine (368) relative to longitudinally extendingarm (364). As grasping surfaces (349, 369) transition from theconfiguration shown in FIGS. 10B and 11B to the configuration shown inFIGS. 10C and 11C, grasping surfaces (349, 369) progressively deflectsuch that initially just the distal tips contact tissue; yet eventually,entire grasping surfaces (349, 369) are involved in grasping tissue.Grasping surfaces (349, 369) are then positioned so that end effector(340) is now located in its second closed configuration. In the secondclosed configuration, ultrasonic blade (342) is positioned a sufficientdistance from clamp pad (346) to allow the operator to capture tissuebetween ultrasonic blade (342) and clamp pad (346) with the forcerequired to cut through and seal tissue with activated ultrasonic blade(342). Therefore, the operator may choose between either performing ablunt dissection (or simply grasping tissue) or operating on tissue withan active ultrasonic blade (342) based on the closed configuration endeffector (340).

While the current example utilizes resiliently flexible material inorder to enable tine (368) to rotate in order to accomplish multipleclosed configurations, any other suitable configuration may be used inorder to allow tine (368) to rotate in response to an external force aswould be apparent to one having ordinary skill in the art in view of theteachings herein. For example, a torsion spring may be provided withincap (362), enabling cap (362) and therefore tine (368) to rotaterelative to blade (361) when an external force is applied to tine (368).The torsion spring or other resilient element may further allow cap(362) and therefore tine (368) to return to position when the externalforce is removed from tine (368).

While the current example shows tine (368) deflecting about thelongitudinal axis defined by ultrasonic blade (342) due to the free endof tine (368) first making contact with clamp tine (348), tine (368) maybe positioned to rotate about any other suitable axis as would beapparent to one having ordinary skill in the art in view of theteachings herein. For example, tine (368) may deflect about an axis thatis perpendicular to the longitudinal axis defined by ultrasonic blade(342) due to a distal end of tine (368) first making contact with clamptine (348). In some such versions, tine (368) extends its effectivelength longitudinally as tine (368) deflects.

While in the current example tine (368) is solely configured to deflect,clamp tine (348) may be configured to deflect alone or in combinationwith guard tine (368).

Additionally, the operator may manipulate tissue by transitioning endeffector (340) from a closed configuration (FIG. 10B or 10C) to an openconfiguration (FIG. 10A). In particular, the operator may insert endeffector (340) in a closed configuration between two organs oranatomical parts that are attached and/or stuck together. Once endeffector (340) is placed in the desired location, the operator may openend effector (340) to separate the two organs or anatomical partswithout exposing ultrasonic blade (342) to the targeted structures. Inother words, clamp arm (344) and blade guard (360) may sufficientlyshield ultrasonic blade (342) from tissue while end effector (340) is ina closed configuration such that end effector (340) may be insertedbetween two organs or anatomical parts in a closed configuration withoutimparting undesired heat to the tissue. Subsequently, end effector (340)may transition to an opened configuration so that the outer surface ofblade guard (360) and the outer surface of clamp arm (344) make contactwith the desired anatomical structure without unwanted contact betweentissue and ultrasonic blade (342).

C. End Effector with Dual Stage Closure and Resilient Blade Guard

FIGS. 12A-13C show another alternative end effector (440) that may bereadily incorporated into ultrasonic surgical instrument (100) describedabove. While end effector (340) is configured to transition from a firstclosed configuration to a second closed configuration based on flexingof guard tine (368), as shown in FIGS. 11B-11C, end effector (440) isconfigured to transition from a first closed configuration, as shown inFIGS. 12B and 13B, to a second closed configuration, as shown in FIGS.12C and 13C. As will be described in greater detail below, the firstclosed configuration may allow an operator to passively grasp and/ormanipulate desired tissue while the second closed configuration mayallow the operator to capture tissue between an ultrasonic blade and aclamp pad with sufficient force required to cut through and seal tissuewith an activated ultrasonic blade.

End effector (440) of this example comprises an ultrasonic blade (442),a clamp arm (444), and a blade guard (460) secured to the distal end ofsheath (132). Ultrasonic blade (442) is integrally connected to awaveguide (438). Ultrasonic blade (442) and waveguide (438) aresubstantially similar to ultrasonic blade (142, 242, 342) and waveguide(138, 238, 338) described above. Therefore, waveguide (438) maycommunicate ultrasonic vibrations to ultrasonic blade (442).

Clamp arm (444) includes a clamp pad (446) facing ultrasonic blade(442). Clamp arm (444) is substantially similar to clamp arm (244, 344)described above while clamp pad (446) is substantially similar to clamppad (246, 346) described above, with differences described below.Therefore, clamp arm (444) is an integral feature of clamp arm assembly(150). Additionally, clamp arm (444) is pivotable toward and away fromultrasonic blade (442) based on pivoting of thumb grip ring (154) towardand away from body (133) of handle assembly (120).

A clamp tine (448) is positioned at the distal end of clamp arm (444).Clamp tine (448) comprises a laterally extending body (447) and agrasping surface (449). Laterally extending body (447) projectslaterally away from the longitudinal axis defined by ultrasonic blade(442), although this is merely optional. The offset position oflaterally extending body (447) relative to the longitudinal axis definedby ultrasonic blade (442) may allow an operator to better visualizeclamp tine (448) during use of end effector (440). Grasping surface(449) includes a flat planar surface in this example, however it shouldbe understood that the flat planar surface is merely optional. Forinstance, grasping surface (449) may comprise a plurality of ridges, aninclined surface, a waved surface, a knurled surface, or have any othersuitable geometry as would be apparent to one having ordinary skill inthe art in view of the teachings herein. As will be described in greaterdetail bellow, clamp tine (448) is configured to rotate with clamp arm(444) toward and away from blade guard (460) to passively grasp and/orperform blunt dissections on targeted tissue.

Blade guard (460) comprises a cap (462), a resiliently flexiblelongitudinal extending arm (464), and a resiliently flexible guard tine(468). Cap (462) is substantially similar to cap (262, 362) as describedabove. Therefore, cap (462) is secured to the distal end of sheath(132). Additionally, cap (462) defines a tubular passage (461), whichwaveguide (438) extends through. As best seen in FIGS. 12A-12C, tubularpassage (461) is sized to accommodate the outer diameter of waveguide(438) such that waveguide (438) does not contact the inner surface ofcap (462) when waveguide (438) mechanically oscillates.

Resiliently flexible longitudinally extending arm (464) is substantiallysimilar to longitudinally extending arm (264, 364) described above, withdifferences described below. Resiliently flexible longitudinallyextending arm (464) is made out of a material that is sufficientlyresilient to flex relative to cap (462) in response to an externalforce; and to return to an unaltered position when the external force isno longer applied.

Longitudinally extending arm (464) extends from cap (462) along thelength of ultrasonic blade (442). As best shown in FIGS. 13A-13C,longitudinally extending arm (464) defines a hollow or concave pathway(465) that houses a portion of ultrasonic blade (442). In particular,longitudinally extending arm (464) may house ultrasonic blade (442) sothat the portion of ultrasonic blade (442) facing toward clamp pad (466)is exposed while the portion of ultrasonic blade (442) facing away fromclamp pad (466) is confined within longitudinally extending arm (464).As will be described in greater detail below, longitudinally extendingarm (464) may act as a heat guard for ultrasonic blade (442).

Concave pathway (465) of longitudinally extending arm (454) isdimensioned to form a gap between the outer diameter of ultrasonic blade(442) and the inner surface of longitudinally extending arm (454)defining concave pathway (465). The gap formed by concave pathway (465)is large enough so that ultrasonic blade (442) does not contact theinner surface of longitudinally extending arm (454) when ultrasonicblade (442) mechanically oscillates. This may prevent unwanted contactbetween ultrasonic blade (442) and blade guard (460).

Guard tine (468) is positioned at the distal end of longitudinallyextending arm (464). Guard tine (468) comprises a laterally extendingbody (467) and a grasping surface (449). Laterally extending body (447)projects laterally away from the longitudinal axis defined by ultrasonicblade (442), although this is merely optional. The offset position oflaterally extending body (467) relative to the longitudinal axis definedby ultrasonic blade (442) may allow an operator to better visualizeguard tine (468) during use of end effector (440). Grasping surface(469) of guard tine (468) forms a flat surface facing toward graspingsurface (449) of clamp tine (448). While in the current example,grasping surface (469) forms a flat surface, this is merely optional.For instance, grasping surface (469) may include a plurality of ridges,an include surface, a waved surface, a knurled surface, or have anyother suitable geometry as would be apparent to one having ordinaryskill in the art in view of the teachings herein.

It should be understood that laterally extending body (467) of guardtine (468) extends in the same general direction of laterally extendingbody (447) of clamp tine (448). Grasping surface (469) of guard tine(468) and grasping surface (449) of clamp tine (448) at least partiallyalign in both longitudinal and lateral directions while end effector(440) is in either the first closed configuration (FIGS. 12B and 13B) orthe second closed configuration (FIGS. 12C and 13C). In other words,grasping surfaces (449, 469) are positioned so that rotation of clamparm (444) toward ultrasonic blade (442) will cause contact betweengrasping surfaces (449, 469) to enable grasping and/or manipulation oftissue between grasping surfaces (449, 469). As will be described ingreater detail below, this may allow for grasping surfaces (449, 469) tointeract with each other in order to passively grasp or passively severtissue captured between grasping surfaces (449, 469) when clamp arm(444) rotates toward ultrasonic blade (442).

FIGS. 12A-13C show end effector (440) transition from an openconfiguration (FIGS. 12A and 13A) to a first closed configuration (FIGS.12B and 13B), and further to a second closed configuration (FIGS. 12Cand 13C). When an operator closes end effector (440) to the first closedconfiguration, as shown from FIGS. 12A-12B and 13A-13B, graspingsurfaces (449, 469) align to grasp tissue. The operator may either moveinstrument (100) in order to move grasped tissue or further rotate tines(448, 468) together in order to form a blunt dissection. However,dimensioning tines (448, 468) to form a blunt dissection by furtherrotating tines (448, 468) is merely optional.

As described above, resiliently flexible longitudinally extending arm(464) is made out of a material that flexes relative to cap (462) inresponse to an external force. As shown in FIGS. 12C and 13C, anoperator may further rotate clamp arm (444) toward ultrasonic blade(442) such that clamp tine (448) imparts an external force on guard tine(468) and longitudinally extending arm (464), thereby flexing arm (464)relative to cap (462). End effector (440) is now located in the secondclosed configuration. In the second closed configuration, ultrasonicblade (442) is positioned a sufficient distance from clamp pad (446) toallow the operator to capture tissue between ultrasonic blade (442) anda clamp pad (446) with the force required to cut through and seal tissuewith activated ultrasonic blade (442). Therefore, an operator may choosebetween either performing a blunt dissection (or simply grasping tissue)or operating on tissue with an active ultrasonic blade (442) based onthe closed configuration end effector (440).

It should be understood that concave pathway (465) is dimensioned tothat resiliently flexible longitudinally extending arm (464) does notmake contact with activated ultrasonic blade (442) while end effector(440) is in the second closed configuration.

Additionally, an operator may manipulate tissue by transitioning endeffector (440) from a closed configuration (FIG. 12B or 12C) to an openconfiguration (FIG. 12A). For instance, the operator may insert endeffector (440) in a closed configuration between two organs oranatomical parts that are attached and/or stuck together. Once endeffector (440) is placed in the desired location, the operator may openend effector (440) to separate the two organs or anatomical partswithout exposing ultrasonic blade (442) to the targeted structures. Inother words, clamp arm (444) and blade guard (460) may sufficientlyshield ultrasonic blade (442) from tissue while end effector (440) is ina closed configuration such that end effector (440) may be insertedbetween two organs or anatomical parts in a closed configuration withoutimparting undesired heat to the tissue. Subsequently, end effector (440)may transition to an opened configuration so that the outer surface ofblade guard (460) and the outer surface of clamp arm (444) make contactwith the desired anatomical structure without unwanted contact betweentissue and ultrasonic blade (442).

D. End Effector with Dual Stage Closure and Resilient Ultrasonic Blade

FIGS. 14A-15C show another alternative end effector (540) that may bereadily incorporated into ultrasonic surgical instrument (100) describedabove. While end effector (340, 440) is configured to transition from afirst closed configuration associated with grasping and/or manipulatingtissue with tines (348, 368, 448, 468) to a second closed configurationassociated with cutting through and sealing tissue with an activatedultrasonic blade (342, 442), end effector (540) of the present exampleis configured to transition from a first closed configuration(associated with cutting through and sealing tissue with an activatedultrasonic blade) to a second closed configuration (associated withgrasping and/or manipulating tissue with tines).

End effector (540) of this example comprises a resiliently flexibleultrasonic blade (542), a clamp arm (544), and a blade guard (560)secured to the distal end of sheath (132). Ultrasonic blade (542) isintegrally connected to a resilient flexible waveguide (538). Ultrasonicblade (542) and waveguide (538) are substantially similar to ultrasonicblade (142, 242, 342, 442) and waveguide (138, 238, 338, 438) describedabove, with differences elaborated below. Therefore, waveguide (538) maycommunicate ultrasonic vibrations to ultrasonic blade (542).

Resiliently flexible waveguide (538) and resiliently flexible ultrasonicblade (542) are made out of a material having sufficient resilience suchthat blade (542) flexes relative to outer sheath (132) in response to anexternal force; and returns to an unaltered position when the externalforce is no longer applied.

Clamp arm (544) includes a clamp pad (546) facing ultrasonic blade(542). Clamp arm (544) is substantially similar to clamp arm (244, 344,444) described above while clamp pad (546) is substantially similar toclamp pad (246, 346, 446) described above, with differences describedbelow. Therefore, clamp arm (544) is an integral feature of clamp armassembly (150). Additionally, clamp arm (544) is pivotable toward andaway from ultrasonic blade (542) based on pivoting of thumb grip ring(154) toward and away from body (133) of handle assembly (120).

A clamp tine (548) is positioned at the distal end of clamp arm (544).Clamp tine (548) comprises a laterally extending body (547) and agrasping surface (549). Laterally extending body (547) projectslaterally away from the longitudinal axis defined by ultrasonic blade(542), although this is merely optional. The offset position oflaterally extending body (547) relative to the longitudinal axis definedby ultrasonic blade (542) may allow an operator to better visualizeclamp tine (548) during use of end effector (540). Grasping surface(549) includes a flat planar surface in this example, however it shouldbe understood that the flat planar surface is merely optional. Forinstance, grasping surface (549) may comprise a plurality of ridges, aninclined surface, a waved surface, a knurled surface, or have any othersuitable geometry as would be apparent to one having ordinary skill inthe art in view of the teachings herein. As will be described in greaterdetail bellow, clamp tine (548) is configured to rotate with clamp arm(544) toward and away from blade guard (560) to passively grasp and/orperform blunt dissections on targeted tissue.

Blade guard (560) comprises a cap (562), a longitudinally extending arm(564) and a resiliently flexible guard tine (568). Cap (562) issubstantially similar to cap (262, 362, 462) as described above.Therefore, cap (562) is secured to the distal end of sheath (132).Additionally, cap (562) defines a tubular passage (561), which waveguide(538) extends through. As best seen in FIGS. 14A-14C, tubular passage(561) is sized to accommodate the outer diameter of waveguide (538) suchthat waveguide (538) does not contact the inner surface of cap (562)when waveguide (538) mechanically oscillates.

Longitudinally extending arm (564) is substantially similar tolongitudinally extending arm (264, 364) described above. Longitudinallyextending arm (564) extends from cap (562) along the length ofultrasonic blade (542). As best shown in FIGS. 15A-15C, longitudinallyextending arm (564) defines a hollow or concave pathway (565) thathouses a portion of ultrasonic blade (542). In particular,longitudinally extending arm (564) may house ultrasonic blade (542) sothat the portion of ultrasonic blade (542) facing toward clamp pad (566)is exposed while the portion of ultrasonic blade (542) facing away fromclamp pad (566) is confined within longitudinally extending arm (564).As will be described in greater detail below, longitudinally extendingarm (564) may act as a heat guard for ultrasonic blade (542).

Concave pathway (565) of longitudinally extending arm (454) isdimensioned to form a gap between the outer diameter of ultrasonic blade(542) and the inner surface of longitudinally extending arm (554)defining concave pathway (565). The gap formed by concave pathway (565)is large enough so that ultrasonic blade (542) does not contact theinner surface of longitudinally extending arm (554) when ultrasonicblade (542) mechanically oscillates. This may prevent unwanted contactbetween ultrasonic blade (542) and blade guard (560).

Guard tine (568) is positioned at the distal end of longitudinallyextending arm (564). Guard tine (568) comprises a laterally extendingbody (567) and a grasping surface (549). Laterally extending body (547)projects laterally away from the longitudinal axis defined by ultrasonicblade (542), although this is merely optional. The offset position oflaterally extending body (567) relative to the longitudinal axis definedby ultrasonic blade (542) may allow an operator to better visualizeguard tine (568) during use of end effector (540). Grasping surface(569) of guard tine (568) forms a flat surface facing toward graspingsurface (549) of clamp tine (548). While in the current example,grasping surface (569) forms a flat surface, this is merely optional.For instance, grasping surface (569) may include a plurality of ridges,an include surface, a waved surface, a knurled surface, or have anyother suitable geometry as would be apparent to one having ordinaryskill in the art in view of the teachings herein.

It should be understood that laterally extending body (567) of guardtine (568) extends in the same general direction of laterally extendingbody (547) of clamp tine (548). Grasping surface (569) of guard tine(568) and grasping surface (549) of clamp tine (548) at least partiallyalign in both longitudinal and lateral directions while end effector(540) is in the second closed configuration, as shown in FIGS. 14C and15C. In other words, grasping surfaces (549, 569) are positioned so thatrotation of clamp arm (544) toward ultrasonic blade (542) will causecontact between grasping surfaces (549, 569) to enable grasping and/ormanipulation of tissue between grasping surfaces (549, 569). As will bedescribed in greater detail below, this may allow for grasping surfaces(549, 569) to interact with each other in order to passively grasp orpassively sever tissue captured between grasping surfaces (549, 569)when clamp arm (544) rotates toward ultrasonic blade (542).

FIGS. 14A-15C show end effector (440) transition from an openconfiguration (FIGS. 14A and 15A) to a first closed configuration (FIGS.14B and 15B), and further to a second closed configuration (FIGS. 14Cand 15C). When an operator closes end effector (540) to the first closedconfiguration, as shown from FIGS. 14A-14B and 15A-15B, clamp pad (546)makes contact with ultrasonic blade (542) while tines (548, 568) arepositioned to a predefined distance from one another. Ultrasonic blade(542) is positioned a sufficient distance from clamp pad (546) to allowthe operator to capture tissue between ultrasonic blade (542) and clamppad (546) with the force required to cut through and seal tissue withactivated ultrasonic blade (542).

Grasping surfaces (449, 469) align to grasp tissue. The operator mayeither move instrument (100) in order to move grasped tissue or furtherrotate tines (448, 468) together in order to form a blunt dissection.

As described above, ultrasonic blade (542) and waveguide (538) are madeout of a material that flexes relative to outer sheath (132) in responseto an external force. As shown in FIGS. 14C and 15C, the operator mayfurther rotate clamp pad (546) against ultrasonic blade (542) such thatclamp pad (546) imparts an external force on ultrasonic blade (542) andwaveguide (538), thereby flexing ultrasonic blade (542) and waveguide(538) relative to outer sheath (132). Grasping surfaces (549, 569) arenow positioned relative to each other in order to grasp tissue. Anoperator may either move instrument (100) in order to move graspedtissue or further rotate tines (548, 568) together in order to perform ablunt dissection. Therefore, an operator may choose between eitherperforming a blunt dissection (or simply grasping tissue) or operatingon tissue with an active ultrasonic blade (542) based on the closedconfiguration end effector (540).

Some versions, ultrasonic blade (542) and waveguide (538) are formed ofa material that flexes relative to outer sheath (132) in response to aperpendicularly directed external force of sufficient magnitude. Inaddition or in the alternative, other elements connected to waveguide(538) may be configured to flex relative to outer sheath (132) inresponse to an external force. Such other elements may be configured toflex or deform in response to external forces that are of a lowermagnitude than the forces required to flex ultrasonic blade (542) andwaveguide (538). For example, a seal (590) made of elastomeric material,positioned about waveguide (538) in outer sheath (132), could deform inresponse to an external force. Thus, the same effect as shown in FIGS.14B-14C and FIGS. 15B-15C could occur due to deformation of seal (590)rather than deformation of blade (542) or waveguide (538). By way ofexample only, such a seal (590) may be constructed and positioned inaccordance with the teachings relating to “seal 83” in U.S. Pub. No.2007/0191713, now abandoned, the disclosure of which is incorporated byreference herein.

Additionally, an operator may manipulate tissue by transitioning endeffector (540) from a closed configuration (FIG. 14B or 14C) to an openconfiguration (FIG. 14A). The operator may insert end effector (540) ina closed configuration between two organs or anatomical parts that areattached and/or stuck together. Once end effector (540) is placed in thedesired location, the operator may open end effector (540) to separatethe two organs or anatomical parts without exposing ultrasonic blade(542) to the targeted structures. In other words, clamp arm (544) andblade guard (560) may sufficiently shield ultrasonic blade (542) fromtissue while end effector (540) is in a closed configuration such thatend effector (540) may be inserted between two organs or anatomicalparts in a closed configuration without imparting undesired heat to thetissue. Subsequently, end effector (540) may transition to an openedconfiguration so that the outer surface of blade guard (560) and theouter surface of clamp arm (544) make contact with the desiredanatomical structure without unwanted contact between tissue andultrasonic blade (542).

III. Exemplary Instrument with Safety Switch for Two Stage Closure

In some instances it may be desirable to provide a safety switch thatallows an operator to activate an ultrasonic blade when the distancebetween ultrasonic blade and clamp pad is sufficient to provide thecompression required to effectively cut through and seal tissue with anactivated ultrasonic blade. This may be useful with an instrument havingtwo stage closure where the first closed configuration allows anoperator to passively grasp and/or manipulate desired tissue while thesecond closed configuration allows an operator to capture tissue betweenan ultrasonic blade and a clamp pad with sufficient compression force tocut through and seal tissue with an activated ultrasonic blade, similarto end effectors (240, 340) described above.

FIGS. 16A-16B show an instrument (200) including a transducer assembly(212), a handle assembly (220), a shaft assembly (230), and clamp armassembly (250); which are substantially similar to transducer assembly(112), handle assembly (120), shaft assembly (130), and clamp armassembly (150) as described above, respectively, with differencesdescribed below. Instrument (200) also includes end effector (240) asdescribed above. As described above, end effector (240) has two closureconfigurations, including a first closed configuration that allows anoperator to passively grasp and/or manipulate desired tissue and asecond closed configuration that allows an operator to capture tissuebetween ultrasonic blade (242) and clamp pad (246) with sufficient forceto cut through and seal tissue with activated ultrasonic blade (242).

Handle assembly (220) include a body (224), a finger grip (224), and apair of buttons (226) that are substantially similar to handle assembly(120), finger grip (124), and buttons (126) as described above,respectively, with differences described below. Buttons (226) areconfigured to activate ultrasonic blade (242) of end effector (240).

Shaft assembly (230) includes an outer sheath (232) and a first switchelement (282). Outer sheath (232) is substantially similar to outersheath (132) as described above. As will be described in greater detailbelow, first switch element (282) is configured to prevent buttons (226)from activating ultrasonic blade (242) when first switch element (282)is not in contact with a second switch element (280). First switchelement (282) is also configured to allow buttons (226) to activateultrasonic blade (242) when in contact with second switch element (280).

Clamp arm assembly (250) includes thumb grip (254), shank (252), andsecond switch element (280). Thumb grip (254) and shank (252) aresubstantially similar to thumb grip (154) and shank (152) describedabove, with differences described below. Pin (256) pivotally couplesclamp arm assembly (250) with outer sheath (232) of shaft assembly(230).

As seem in FIGS. 16A-16C, second switch element (280) is located onshank (252) such that as clamp arm assembly (250) pivots toward body(222), second switch element (280) pivots toward first switch element(282). FIG. 16A depicts end effector (240) in a position correspondingto FIGS. 10A and 11A. Therefore, end effector (240) is in an openconfiguration in FIG. 16A. It should be understood that if an operatorattempts to press buttons (226) with end effector (240) in the openconfiguration of FIG. 16A, ultrasonic blade (242) of end effector (240)will not activate because first switch element (282) is not in contactwith second switch element (280).

FIG. 16B depicts end effector (240) in a position corresponding to FIGS.10B and 11B. Therefore, end effector (240) is in the first closedconfiguration in FIG. 16B. At this point, end effector (240) is capableof grasping tissue or manipulating tissue with tines (248, 268).However, clamp pad (246) and ultrasonic blade (242) are not close enoughsuch that activation of ultrasonic blade (242) would cut and seal tissuecaptured between clamp pad (246) and ultrasonic blade (242). It shouldbe understood that if an operator attempts to press buttons (226),ultrasonic blade (242) of end effector (240) will not activate becausefirst switch element (282) is still not yet in contact with secondswitch element (280).

FIG. 16C depicts end effector (240) in a position corresponding to FIGS.10C and 11C. Therefore, end effector (240) is in the second closedconfiguration in FIG. 16C. At this point, end effector (240) is capableof capturing tissue between clamp pad (246) and ultrasonic blade (242)with sufficient compression force such that activation of ultrasonicblade (242) would cut and seal tissues captured between clamp pad (246)and ultrasonic blade (242). It should be understood that first switchelement (282) and second switch element (280) are now in contact witheach other. Therefore, ultrasonic blade (242) will be ultrasonicallyactivated when the operator presses either button (226) at this stage.

It should be understood from the foregoing that first switch element(282) and second switch element (280) ensure that when an operatorpresses buttons (226) to activate ultrasonic blade (242), there issufficient compression force provided between clamp pad (246) andultrasonic blade (242). It should also be understood that end effector(340) or any other suitable end effector with two stage closure may beutilized with instrument (200) in replacement of end effector (240).

IV. Exemplary End Effector with Ultrasonic Blade Distal of LaterallyExtending Tines

In some instances, it may be desirable to have an end effector with anultrasonic blade extending distally in relation to laterally extendingtines. A portion of ultrasonic blade extending distally in relation tolaterally extending tines may add more functionality. For instance, anoperator may use such a distal portion of ultrasonic blade for otomycreation when the blade is energized.

FIGS. 17-19 show an exemplary end effector (640) that may be readilyincorporated into instrument (100, 200) in place of end effector (140,240). End effector (640) of this example includes an ultrasonic blade(642), a clamp arm (644), and a blade guard (660). Clamp arm (644) maybe substantially similar to clamp arm (244, 344, 444, 544) describedabove. Clamp arm (644) includes clamp pad (646) and clamp tine (648),which may be substantially similar to clamp pad (246, 346, 446, 546) andclamp tine (248, 348, 448, 548), respectively described above.Therefore, clamp tine (648) includes a laterally extending body (647)and a grasping surface (649) that may be substantially similar tolaterally extending body (247, 347, 447, 547) and grasping surface (249,349, 449, 549), respectively described above.

Blade guard (660) includes a cap (662), a longitudinally extending arm(664) and a guard tine (668), which may be substantially similar to cap(262, 362, 462, 562), longitudinally extending arm (264, 364, 464, 564),and guard tine (268, 368, 468, 568), respectively, described above withdifferences described below. Therefore, guard tine (668) includes alaterally extending body (667) and a grasping surface (669), which maysubstantially similar to laterally extending body (267, 367, 467, 567)and grasping surface (269, 369, 496, 569), respectively described above,with difference described below. Additionally, longitudinally extendingarm (664) defines a hollow or concave pathway (665) substantiallysimilar to concave pathway (265, 365, 465, 565) described above.

Ultrasonic blade (642) may be substantially similar to ultrasonic blade(142, 242, 342, 442, 552) mentioned above, with differences describedbelow. Ultrasonic blade (642) includes a distal end (643) extendingdistal in relation to guide tine (668). Guide tine (668) defines adistal opening (666) to accommodate distal end (643) of ultrasonic blade(642). It should be understood that distal opening (666) is dimensionedsuch that guide tine (668) does not contact ultrasonic blade (642)during mechanical oscillation of ultrasonic blade (642). Distal end(643) of ultrasonic blade (642) extends distally past the bend formed byguard tine (668), to a sufficient distance to allow distal end (643) ofultrasonic blade (642) to be inserted into a targeted anatomicalstructure in order to create an otomy in the anatomical structure whenultrasonic blade (642) is activated. Distal end (643) of ultrasonicblade (642) may also take on other functions, such as a scalpel or anyother suitable function as would be apparent to one having ordinaryskill in the art in view of the teachings herein.

It should be understood that end effector (640) may incorporate any ofthe closing features of end effector (240, 340, 440, 540) as would beapparent to one having ordinary skill in the art in view of theteachings herein. Therefore, distal opening (666) may be dimensioned toaccommodate for any of the other features present in end effector (240,340, 440, 540) without making contact with ultrasonic blade (642).

In some versions, ultrasonic blade (642) is retractable from a distalposition, as shown in FIGS. 17-19, to a proximal position. Whenultrasonic blade (642) is in the proximal position, distal end (643) ofultrasonic blade (642) is located within the confines of concave pathway(665). A slide switch or other actuator may be operable to selectivelytranslate transducer assembly (112) and ultrasonic blade (642) distallyto expose distal end (643) of ultrasonic blade (642) past distal opening(666). The same slide switch or actuator may be operable to selectivelytranslate transducer assembly (112) and ultrasonic blade (642)proximally to retract distal end (643) of ultrasonic blade (642) backinto distal opening (666). Various suitable components, configurations,and techniques that may be used to provide longitudinal translation oftransducer assembly (112) and ultrasonic blade (642), to selectivelyexpose and conceal distal end (643), will be apparent to those ofordinary skill in the art in view of the teachings herein.

V. Exemplary Instrument with Two Independent Tines

In some instances, it may be desirable to have two tines that are bothpivotable relative to ultrasonic blade (142). FIGS. 20-21B show anexemplary instrument (700) that provides such functionality. Instrument(700) includes a handle assembly (720), a shaft assembly (730), endeffector (740), and a clamp arm assembly (750). A transducer assembly(712) is fixed to body (722). Handle assembly (720) and transducerassembly (712) are substantially similar to handle assembly (120) andtransducer assembly (112) described above, with differences describedbelow.

Handle assembly (120) includes a body (722) including a body finger grip(724), a body thumb grip (728), and a pair of buttons (726). Buttons aresubstantially similar to buttons (126) described above. Shaft assembly(730) includes an outer sheath (732). Clamp arm assembly (750) includesa first shank (752) unitarily connected to a thumb grip ring (754), anda second shank (772) unitarily connected to a shank finger grip (774).First shank (752) and second shank (772) are pivotally connected toshaft assembly (730) and handle assembly (720) via a pin (756).Therefore, an operator may pivot first shank (752) and second shank(772) relative to handle assembly (722).

End effector (740) includes an ultrasonic waveguide (738) unitarilyconnected to an ultrasonic blade (742), which are substantially similarto ultrasonic waveguide (138) and ultrasonic blade (142) describedabove. Therefore, an operator may press buttons (726) in order toactivate transducer assembly (712), which generates ultrasonicvibrations that travel through ultrasonic waveguide (738) to ultrasonicblade (742). Ultrasonic waveguide (738) extends distally from outersheath (732).

End effector (740) also includes a clamp arm (744) integrally connectedto first shank (752) and extending distally from pin (756). Therefore,an operator may pivot first shank (752) toward body (722), which in turnpivots clamp arm (744) toward ultrasonic blade (742). Clamp arm (744)includes a clamp pad (746) and a first tine (748). Clamp pad (746) maybe substantially similar to clamp pad (226) described above. First tine(748) includes a laterally extending body (748) and a grasping surface(749), which are substantially similar to laterally extending body (248)and grasping surface (249), respectively. In some alternative versions,first tine (748) is omitted.

End effector (740) also includes a clamp arm (764) integrally connectedto second shank (772) and extending distally from pin (756). Therefore,an operator may pivot second shank (772) toward body (722), which inturn pivots clamp arm (764) toward ultrasonic blade (742). Clamp arm(764) includes a clamp pad (766) and a second tine (768). Second tine(768) includes a laterally extending body (767) and a grasping surface(769) which mirror laterally extending body (747) and grasping surface(749) of first tine (748). In some alternative versions, second tine(768) is omitted.

As seen in from FIGS. 21A-21B, an operator may grasp shank thumb grip(754) and shank finger grip (774) in order to pivot first tine (748) andsecond tine (768) toward each other. Grasping surfaces (749, 769) maythen pivot close enough in order grasp; or grasping surfaces (749, 769)may pivot further in order to for a blunt dissection. First tine (748)and second tine (768) may be indexed relative to one another through agear and/or other component(s), such that both tines (748, 768) closesymmetrically relative to each other. Various suitable components,configurations, and techniques that may be used to provide such indexingmethod will be apparent to one having ordinary skill in the art in viewof the teachings herein.

An operator may also pivot either first shank (752) or second shank(772) toward body (722) in order to capture tissue between ultrasonicblade (742) and either clamp pad (746, 766) respectively. An operatormay then press buttons (726) in order to cut and seal tissue capturedbetween ultrasonic blade (742) and either clamp pad (746, 766)respectively. Body thumb grip (728) and body finger grip (724) areprovided for an operator to grasp depending on which shank (752, 772) anoperator decides to utilize in order to grasp tissue between ultrasonicblade (742) and either clamp pad (746, 766) respectively. For instance,if an operator decides to grasp tissue between first clamp arm (744) andultrasonic blade (742), an operator may place their thumb in shank thumbgrip (754) and their finger in body finger grip (724) in order to pivotfirst shank (752) toward body (722).

It should be understood that grip (724) may be configured to engage grip(774) when shank (772) completes a full range of motion during closureof clamp arm (764) toward blade (742). In other words, grip (724) mayarrest motion of clamp arm (764) toward blade (742) when grip (774)engages blade (742). Similarly, grip (728) may be configured to engagegrip (754) when shank (752) completes a full range of motion duringclosure of clamp arm (744) toward blade (742). In other words, grip(728) may arrest motion of clamp arm (744) toward blade (742) when grip(754) engages blade (742). Alternatively, grips (724, 728) may beconfigured or positioned such that grips (754, 774) do not engage grips(724, 728). In some versions, grips (724, 728) are simply omitted.

It should also be understood from the foregoing that an operator maychoose between either performing a blunt dissection (or simply graspingtissue) or operating on tissue with an active ultrasonic blade (742)with one single end effector (740).

In some instances, it may desirable to make tines (248, 268, 348, 368,448, 468, 548, 568, 648, 668, 748, 768) removable and replaceable fromthe rest of end effector (240, 340, 440, 540, 640, 740) respectively.This way, an operator may choose tines (248, 268, 348, 368, 448, 468,548, 568, 648, 668, 748, 768) with different geometries as discussedabove, based on whichever geometry best suits the surgical operation athand. Additionally, tines (248, 268, 348, 368, 448, 468, 548, 568, 648,668, 748, 768) may be removed and replaced during a surgical operationthat requires grasping tissue at multiple locations, which may notnecessarily be completed easily by a single set of tines (248, 268, 348,368, 448, 468, 548, 568, 648, 668, 748, 768).

Additionally, or alternatively, tines (248, 268, 348, 368, 448, 468,548, 568, 648, 668, 748, 768) may be made of a low thermal conductionmaterial, such as ceramic. This may allow end effector (240, 340, 440,540, 640, 740) to apply bipolar RF energy to a surgical site such thattines (248, 268, 348, 368, 448, 468, 548, 568, 648, 668, 748, 768) wouldbe non-conductive both thermally and electrically.

Additionally, or alternatively, a leaf spring or other resilient biasingmechanism may be placed behind clamp pad (246, 346, 446, 546, 646, 756,766) to ensure that clamp pad (246, 346, 446, 546, 646, 756, 766)applies the appropriate force as well as deflect when tines (248, 268,348, 368, 448, 468, 548, 568, 648, 668, 748, 768) rotate toward eachother to a closed configuration. By way of example only, such aresilient biasing mechanism may be provided in accordance with at leastsome of the teachings of U.S. Pub. No. 2015/0148834, issued as U.S. Pat.No. 10,004,527 on Jun. 26, 2018, entitled “Ultrasonic SurgicalInstrument with Staged Clamping,” published May 28, 2015, the disclosureof which is incorporated by reference herein.

Additionally, or alternatively, concave pathway (265, 365, 465, 565,665, 765) may further define a slot in order to allow blade (242, 342,442, 542, 642, 742) to further deflect more easily while also avoidingcontact between blade (242, 342, 442, 542, 642, 742) and longitudinallyextending arm (264, 364, 464, 564, 664, 764).

Additionally, or alternatively, blade (242, 342, 442, 542, 642, 742)could have a curved profile while tines (248, 268, 348, 368, 448, 468,548, 568, 648, 668, 748, 768) extend past blade (242, 342, 442, 542,642, 742) along the same curved profile (e.g., on the same radius ofcurvature).

VI. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

An apparatus for operating on tissue, the apparatus comprising: (a) abody assembly; (b) a shaft extending distally from the body assembly;(c) an acoustic waveguide; and (d) an end effector comprising: (i) anultrasonic blade in acoustic communication with the waveguide, (ii) aclamp arm configured to pivot toward and away from the ultrasonic blade,wherein the clamp arm comprises a first tine, and (iii) a blade guardextending from the shaft, wherein the blade guard comprises alongitudinally extending arm defining a concave pathway and a secondtine located distal to the longitudinally extending arm; wherein theultrasonic blade is partially housed within the concave pathway, whereinthe first tine and the second tine are configured to grasp tissue whenthe clamp arm pivots toward the ultrasonic blade.

Example 2

The apparatus of Example 1, wherein the ultrasonic blade defines alongitudinal axis, wherein the first tine and the second tine extendtransversely relative to the longitudinal axis.

Example 3

The apparatus of any one or more of Examples 1 through 2, wherein thefirst tine defines a plurality of ridges.

Example 4

The apparatus of any one or more of Examples 1 through 3, wherein theclamp arm further comprises a clamp pad facing the ultrasonic blade.

Example 5

The apparatus of any one or more of Examples 1 through 4, wherein theclamp arm is configured to pivot toward the ultrasonic blade from anopen configuration to a first closed configuration, wherein the firsttine and the second tine are configured to grasp tissue in the firstclosed configuration, wherein the clamp arm is configured to pivotfurther toward the ultrasonic blade from the first closed configurationto a second closed configuration, wherein the ultrasonic blade isconfigured to cut tissue in the second closed configuration.

Example 6

The apparatus of Example 5, wherein the blade guard is configured toflex when the clamp arm transitions from the first closed configurationto the second closed configuration.

Example 7

The apparatus of Example 6, wherein the second tine is configured toflex relative to the longitudinally extending arm when the clamp armtransitions from the first closed configuration to the second closedconfiguration.

Example 8

The apparatus of any one or more of Examples 6 through 7, wherein thelongitudinally extending arm is configured to flex relative to the shaftwhen the clamp arm transitions from the first closed configuration tothe second closed configuration.

Example 9

The apparatus of any one or more of Examples 6 through 8, wherein theconcave pathway is dimensioned to prevent contact between the bladeguard and the ultrasonic blade when the clamp arm is in the secondclosed configuration.

Example 10

The apparatus of any one or more of Examples 8 through 9, wherein theultrasonic blade defines a longitudinal axis, wherein the longitudinallyextending arm is configured to flex along the longitudinal axis when theclamp arm transitions from the first closed configuration to the secondclosed configuration.

Example 11

The apparatus of any one or more of Examples 5 through 10, wherein theapparatus further comprises a safety switch configured to selectivelyprevent activation of the ultrasonic blade.

Example 12

The apparatus of Example 11, wherein the safety switch is configured toselectively allow activation of the ultrasonic blade when the clamp armis in the second closed configuration.

Example 13

The apparatus of any one or more of Examples 1 through 12, wherein thesecond tine defines a distal opening, wherein the ultrasonic bladeextends from the concave pathway through the distal opening.

Example 14

The apparatus of any one or more of Examples 1 through 13, wherein theclamp arm is unitarily connected to a shank, wherein the shank ispivotally coupled to the shaft via a pin.

Example 15

The apparatus of any one or more of Examples 1 through 14, wherein theclamp arm is configured to pivot toward the ultrasonic blade from anopen configuration to a first closed configuration, wherein theultrasonic blade is configured to cut tissue in the first closedconfiguration, wherein the clamp arm is configured to pivot toward theultrasonic blade from the first closed configuration to a second closedconfiguration, wherein the first tine and the second tine are configuredto grasp tissue in the second closed configuration.

Example 16

The apparatus of Example 15, wherein the ultrasonic blade is configuredto flex when the clamp arm pivots from the first closed configuration tothe second closed configuration.

Example 17

An apparatus for operating on tissue, the apparatus comprising: (a) abody assembly; (b) a shaft extending distally from the body assembly;(c) an acoustic waveguide; and (d) an end effector comprising: (i) anultrasonic blade in acoustic communication with the waveguide, (ii) aclamp arm comprising a first distal end and a clamp pad, wherein theclamp arm is configured to pivot toward and away the ultrasonic blade,wherein the clamp pad faces the ultrasonic blade, (iii) a blade guardextending from the shaft, wherein the blade guard comprises a seconddistal end, wherein the blade guard partially houses the ultrasonicblade, (v) a first tine attached to the first distal end of the clamparm, wherein the first tine extends transversely relative to alongitudinal axis defined by the clamp arm, and (iv) a second tineattached to the second distal end of the blade guard, wherein the secondtine extends transversely relative to a longitudinal axis defined by theblade guard; wherein the first tine and the second tine are configuredto grasp tissue when the clamp arm pivots toward the ultrasonic blade.

Example 18

The apparatus of Example 17, wherein the blade guard is configured toflex in response to the clamp arm pivoting toward the ultrasonic blade.

Example 19

The apparatus of Example 18, wherein the second tine is configured toflex relative to the blade guard in response to the clamp arm pivotingtoward the ultrasonic blade.

Example 20

An apparatus for operating on tissue, the apparatus comprising: (a) abody assembly; (b) a shaft extending distally from the body assembly;(c) an acoustic waveguide comprising a first side and a second side,wherein the first side is opposite the second side; and (d) an endeffector comprising: (i) an ultrasonic blade in acoustic communicationwith the waveguide, (ii) a first clamp arm configured to pivot towardand away from the first side of the ultrasonic blade, wherein the clamparm comprises a first tine, and (iii) a second clamp arm configured topivot toward and away from the second side of the ultrasonic blade,wherein the second clamp arm comprises a second tine;

wherein the first tine and the second tine are configured to grasptissue when the first clamp arm pivots toward the first side of theultrasonic blade and the second clamp arm pivots toward the second sideof the ultrasonic blade.

VII. Miscellaneous

It should be understood that any of the versions of instrumentsdescribed herein may include various other features in addition to or inlieu of those described above. By way of example only, any of theinstruments described herein may also include one or more of the variousfeatures disclosed in any of the various references that areincorporated by reference herein. It should also be understood that theteachings herein may be readily applied to any of the instrumentsdescribed in any of the other references cited herein, such that theteachings herein may be readily combined with the teachings of any ofthe references cited herein in numerous ways. Other types of instrumentsinto which the teachings herein may be incorporated will be apparent tothose of ordinary skill in the art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” published Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by an operatorimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

I claim:
 1. An apparatus for operating on tissue, the apparatuscomprising: (a) a body assembly; (b) a shaft extending distally from thebody assembly; (c) an acoustic waveguide; and (d) an end effectorcomprising: (i) an ultrasonic blade in acoustic communication with thewaveguide, (ii) a clamp arm configured to pivot toward and away from theultrasonic blade, wherein the clamp arm comprises a first tine, and(iii) a blade guard extending from the shaft, wherein the blade guardcomprises a longitudinally extending arm defining a concave pathway anda second tine located distal to the longitudinally extending arm;wherein the second tine has a gasping surface extending along an upperplane, wherein the ultrasonic blade is partially housed within theconcave pathway such that the blade guard is transversely above theultrasonic blade and the ultrasonic blade is transversely between theblade guard and the clamp arm, wherein the first tine and the secondtine are configured to grasp tissue when the clamp arm pivots toward theultrasonic blade, wherein at least a portion of the ultrasonic blade ispositioned transversely below the upper plane of the second tine towardthe clamp arm.
 2. The apparatus of claim 1, wherein the ultrasonic bladedefines a longitudinal axis, wherein the first tine and the second tineextend transversely relative to the longitudinal axis.
 3. The apparatusof claim 1, wherein the clamp arm further comprises a clamp pad facingthe ultrasonic blade.
 4. The apparatus of claim 3, wherein the firsttine has another grasping surface extending along a lower plane, andwherein the clamp pad is positioned transversely below the lower planeof the first tine away from the ultrasonic blade.
 5. The apparatus ofclaim 1, wherein the longitudinally extending arm is unitarily formedwith the blade guard.
 6. The apparatus of claim 1, wherein the clamp armis configured to pivot toward the ultrasonic blade from an openconfiguration to a first closed configuration, wherein the first tineand the second tine are configured to grasp tissue in the first closedconfiguration, wherein the clamp arm is configured to pivot furthertoward the ultrasonic blade from the first closed configuration to asecond closed configuration, wherein the ultrasonic blade is configuredto cut tissue in the second closed configuration.
 7. The apparatus ofclaim 6, wherein the blade guard is configured to flex when the clamparm transitions from the first closed configuration to the second closedconfiguration.
 8. The apparatus of claim 7, wherein the second tine isconfigured to flex relative to the longitudinally extending arm when theclamp arm transitions from the first closed configuration to the secondclosed configuration.
 9. The apparatus of claim 7, wherein thelongitudinally extending arm is configured to flex relative to the shaftwhen the clamp arm transitions from the first closed configuration tothe second closed configuration.
 10. The apparatus of claim 7, whereinthe concave pathway is dimensioned to prevent contact between the bladeguard and the ultrasonic blade when the clamp arm is in the secondclosed configuration.
 11. The apparatus of claim 9, wherein theultrasonic blade defines a longitudinal axis, wherein the longitudinallyextending arm is configured to flex along the longitudinal axis when theclamp arm transitions from the first closed configuration to the secondclosed configuration.
 12. The apparatus of claim 6, wherein the safetyswitch is configured to selectively allow activation of the ultrasonicblade when the clamp arm is in the second closed configuration.
 13. Theapparatus of claim 1, wherein the second tine has a distal tine end thatdefines a distal opening in longitudinal alignment with the ultrasonicblade, wherein the ultrasonic blade extends longitudinally past thedistal tine end of the second tine from the concave pathway through thedistal opening.
 14. The apparatus of claim 1, wherein the clamp arm isunitarily connected to a shank, wherein the shank is pivotally coupledto the shaft via a pin.
 15. The apparatus of claim 1, wherein the clamparm is configured to pivot toward the ultrasonic blade from an openconfiguration to a first closed configuration, wherein the ultrasonicblade is configured to cut tissue in the first closed configuration,wherein the clamp arm is configured to pivot toward the ultrasonic bladefrom the first closed configuration to a second closed configuration,wherein the first tine and the second tine are configured to grasptissue in the second closed configuration.
 16. The apparatus of claim15, wherein the ultrasonic blade is configured to flex when the clamparm pivots from the first closed configuration to the second closedconfiguration.
 17. An apparatus for operating on tissue, the apparatuscomprising: (a) a body assembly; (b) a shaft extending distally from thebody assembly; (c) an acoustic waveguide; and (d) an end effectorcomprising: (i) an ultrasonic blade in acoustic communication with thewaveguide, (ii) a clamp arm comprising a first distal end and a clamppad, wherein the clamp arm is configured to pivot toward and away theultrasonic blade, wherein the clamp pad faces the ultrasonic blade,(iii) a blade guard extending from the shaft, wherein the blade guardcomprises a second distal end, wherein the blade guard partially housesthe ultrasonic blade, (v) a first tine attached to the first distal endof the clamp arm, wherein the first tine extends transversely relativeto a longitudinal axis defined by the clamp arm, and (iv) a second tineattached to the second distal end of the blade guard, wherein the secondtine extends transversely relative to a longitudinal axis defined by theblade guard; wherein the first tine and the second tine are configuredto grasp tissue when the clamp arm pivots toward the ultrasonic blade,wherein the second tine has a distal tine end that defines a distalopening in longitudinal alignment with the ultrasonic blade, wherein theultrasonic blade extends longitudinally past the distal tine end of thesecond tine from the concave pathway through the distal opening.
 18. Theapparatus of claim 17, wherein the blade guard is configured to flex inresponse to the clamp arm pivoting toward the ultrasonic blade.
 19. Theapparatus of claim 18, wherein the second tine is configured to flexrelative to the blade guard in response to the clamp arm pivoting towardthe ultrasonic blade.
 20. An apparatus for operating on tissue, theapparatus comprising: (a) a body assembly; (b) a shaft extendingdistally from the body assembly; (c) an acoustic waveguide comprising afirst side and a second side, wherein the first side is opposite thesecond side; and (d) an end effector comprising: (i) an ultrasonic bladein acoustic communication with the waveguide, (ii) a first clamp armconfigured to pivot toward and away from the first side of theultrasonic blade, wherein the clamp arm comprises a first tine, and(iii) a second clamp arm configured to pivot toward and away from thesecond side of the ultrasonic blade, wherein the second clamp armcomprises a second tine; wherein the first clamp arm and the secondclamp arm pivot relative to each other, wherein the first tine and thesecond tine are configured to grasp tissue when the first clamp armpivots toward the first side of the ultrasonic blade and the secondclamp arm pivots toward the second side of the ultrasonic blade.